Chapter 2. Patient Assessment
2.6 Head-to-Toe Assessment: head and neck / Neurological Assessment
The neurological system is responsible for all human function. It exerts unconscious control over basic body functions, and it also enables complex interactions with others and the environment (Stephen, Skillen, Day, & Jensen, 2012). A neurological assessment begins when the nurse first interacts with the client and involves observations about appearance, communication patterns, and general behaviour. The first part of the checklist provides a general overview of performing a basic neurological assessment. In some situations a more focused neurological assessment is necessary. The last part of the checklist provides some guidelines for some elements of a focused neurological assessment.
Checklist 16 provides a guide for subjective and objective data collection in a neurological assessment.
Objective DataConsider the following observations.
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Steps |
Additional Information |
| General appearance | Observations about general appearance may provide insight into other physical or psychosocial issues affecting the patient.
If appearance is unkempt, it may suggest that the patient struggles with achieving activities of daily living. The nurse would further their questioning to elicit greater understanding, and potentially to refer to other healthcare professionals subsequently.
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| Level of consciousness (LOC)
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Altered LOC may indicate substance use, fatigue, brain injury, neurological disorder, mania, or depression. |
| Inspect eyes & nose for drainage.
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Drainage from eyes or nose may indicate infection, allergy, or injury. |
| Note nature of eye contact during interview.
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The extent of eye contact may reflect cultural norms, individual way of being, or possibly mental health issues. |
| Glasses, contacts, hearing aids
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People who need these devices but don’t have them, or if the devices are not in working order, may experience some level of isolation because of difficulty interacting with the world around them. |
| Inspect for facial asymmetry. | Facial asymmetry may indicate neurological impairment or injury. Unusual findings should be followed up with a focused neurological system assessment. |
| Evidence of nasal trauma. Ability to breathe through nose.
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Nasal flaring or use of accessory muscles when breathing may indicate altered breathing patterns. Unusual findings should be followed-up with a focused respiratory assessment. |
| Inspect mouth, tongue, and teeth for moisture, colour, dentures, hygiene.
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Dry mucous membranes may indicated altered hydration. Dental disease can influence one’s general health. |
| Ability to swallow
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Difficulty swallowing may suggest neurological impairment. Frequent coughing or choking associated with eating or drinking may suggest risk of aspiration. Unusual finding should be followed-up with a swallow assessment and a referral to an occupational therapist. |
| Neck range of motion (ROM)
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This includes flexio